General Question

shrubbery's avatar

What is clinical depression and how is it diagnosed?

Asked by shrubbery (9835 points ) October 16th, 2008

First off, just in case anyone is offended, I apologise. I’m just not really sure how it works and I’m sure I couldn’t possibly know unless I experience it but I’m just wondering about it, and thought that I’d be much better off asking intelligent Flutherites rather than perusing shady “medical” websites.

What makes depression clinical or a mental disorder rather than just being down and gloomy?

Does it have to last for a certain amount of time? Do there have to be physical symptoms as well?

How could one possibly know if they were clinically depressed? Do you book yourself in to a doctor because you’re worried about yourself or does it get to a stage where someone else has to book you in?

Ok, I admit I did google first and came across this and I’m probably experiencing about 15 of those symptoms, yet I hardly think I’m clinically depressed. I know the internet isn’t to be trusted on these issues, but really, what makes someone clinically depressed?

Sorry again, I know this is a tough subject, but I’m just trying to learn.

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21 Answers

marinelife's avatar

This site has a clear explanation and details on the various types.

“When is sadness, gloom or “feeling down” normal and when is it a more serious problem? Clinical Depression differs from normal sadness or “the blues” in both the severity of symptoms and in duration. Normal sadness usually does not affect all areas of a person’s life and goes away in a few hours or days. Sometimes a shopping trip or being with friends will cause sadness to disappear. Clinical depression lasts for much longer periods of time and has more symptoms. The rule of thumb is that if sadness lasts for longer than two weeks, it is probably clinical depression. This type of depression often interferes with everyday functioning. Clinical depression is a serious disorder which needs to be evaluated by a professional and usually requires some form of treatment.”

nikipedia's avatar

I have a long, technical answer to this question, but here is the short version: if you are so unhappy that it’s interfering with your life, who cares what it’s called? Go to the doctor. Get help. Life should be better than that.

augustlan's avatar

If it is the first time a person is experiencing clinical depression, they will often not even realize it. It can take someone else to point it out and suggest seeking help.

AlfredaPrufrock's avatar

I would suggest start with your primary care doctor, and explain what you’re going to. Often a doctor will refer you to a psychologist for talk therapy, who cannot write scripts, but may make a recommendation for medication that your primary doctor will have to write the prescription for.

I have to agree with Augustian; sometimes you will not recognize depression because you’ve been so used to it. It’s not that you’re expected to feel bubbly happy, but you are supposed to be able to get out of bed, or out of the car, without it taking a herculean effort, and you should be able to bathe, brush your teeth and hair, eat, clean house, without having to force yourself to do so.

It’s far more common than you think; don’t apologize for it.

shrubbery's avatar

Ok, I must apologise because I didn’t mean to say that I think I might have it, I’m just curious as to what makes it clinically diagnosable.

Niki, I’d like to hear your long, technical answer if you have some spare time :)

Thanks for the link, Marina, I’ll have a read.

wundayatta's avatar

I’ve been diagnosed with a form of it, and I still don’t believe it sometimes. I mean, it hurts bad, but part of me refuses to let me believe I am at the mercy of this thing.

It’s really confusing. The shrink tells you the diagnosis, but inside you feel exactly the same after the diagnosis as you did before.

The major issue seems to be responsibility. If one can work one’s way out of depression on one’s own, it’s different from trying to get out, and failing. When I fail, I feel even worse, and I blame myself for being incompetent. I am unwilling to accept that this is something that my brain is doing—that it’s not me. It feels like me. I’m sure this sounds hopelessly confused.

Depression has all kinds of fun things. So for the last few days I was running around constantly thinking how fucking worthless I am, and a number of other scripts I can’t remember now—or yeah—“I suck” was one of my favorites.

How about being unable to make a phone call? How about being sure you will fail at everything you do? How about feeling unloved when everyone around you loves you? Oh yeah. How about contemplating which of the many suicide methods would be appropriate for me today? (fortunately, I am able to not take that one seriously, but that’s been work).

These are not things I felt at other times in life when I was down. Drugs help—I think. Again, it’s hard to tell. I resist thinking it’s the drugs, because then I feel powerless. This thing can happen at any time, and I can’t stop it. But I also resist thinking it’s me, because if it’s me, and I do have power over it, and I’m still sick, then I must want to be sick. I can have a great time beating myself up with that one. Ah the joys of an intricate mind!

Today, my therapist said I could dispense with the fighting it. It just isn’t working. We’re switching to “mindfullness.” I have an idea about what that is, but I don’t know if it has anything to do with what other people think it is. I’m not sure it matters.

Part of my therapy is to write about it every chance I get. I’m not sure how this helps, but it’s an interesting challenge.

SuperMouse's avatar

Daloon did an excellent job of describing the feelings that come along with clinical depression. From my own experience with depression I would add that I realized there must be something chemically wrong with my brain when I was seriously contemplating suicide when everything in my life was truly fine. That frightened me and that is when I decided to seek help. For me depression was kind of like bad eyesight. I didn’t realize how bad my eyes were until I got glasses and could see things clearly. I didn’t realize how depressed I had been until I got stable on medication.

wundayatta's avatar

Ah Supermouse. How do you feel about needing meds to be ok? I don’t mean this in the “mental illness is like high blood pressure, you wouldn’t not take blood pressure meds, would you?” kind of way. I mean about the sort of existential (to me, anyway) issue of which you is you.

You’ve said you now think the bad feelings were analogous to bad eyesight, and the drugs are like corrective lenses. Maybe you’re not as stubborn as I am. Or maybe you’re just further along on the wellness track than I am. Or maybe it’s just that I’m more comfortable being in that place where I hate myself, as my therapist says. But the you when you’re not medicated—is that you?

Or perhaps you’re saying it’s the real you (just as your eyes are your real eyes whether you’re wearing glasses or not) and you prefer to deal with the world with glasses (meds) on? Although, with brains, it’s trickier, because of the consciousness and internal experience of reality kind of thing. And it affects how other people around us think of us. They like us better on meds, and who can blame them? I’m just wondering. I don’t have answers for these questions. Not everyone even wants to think about them.

SuperMouse's avatar

When I got to a point where I was nearly incapacitated by my depression, anxiety and manic episodes, I knew I had no choice but to find the right meds. The me on meds is as much the me as the me without meds, but the me on meds is not suicidal, is a much better mom to my kids, and is much happier and healthier.

I’ll admit to spending a lot of time hating myself and wishing I could do it on my own. After a while I finally came around to realizing that was not in the cards and if I ever wanted to live on a more even keel and a more fulfilling life, I had no choice but to manage my illness.

I am sure that others like me better now that I have been stable for several years, but I am also sure that I like myself better as well. I am better able to cope with stress, to manage day to day life, and to make rational decisions and face whatever may come my way.

It’s a long road Daloon, there is no question about that. Mental illness still carries a stigma which makes the process even more difficult.

augustlan's avatar

I spent years railing against the drugs, even to the point of “forgetting” to take them for days on end. Then I moved on to the thinking of the drugs as a temporary thing…“once I get better, I can stop taking them”. As you can imagine, that was a load of crap. After several cycles of that, combined with therapy (with the goal of getting better, once and for all), I finally understood: No amount of therapy (even though it helped me immensely), or wanting to be well was going to make my life bearable. What does? The drugs. Period. Once I was able to accept the fact that I’d have to take them for the rest of my life, I was really able to ease up on myself about the guilt. I don’t even need therapy anymore. I do “check in” when something tough happens, but on a day-to-day basis, I am at peace. I hope you find it, too.

wundayatta's avatar

I suppose I’m quite impatient. It seemed like the drugs were working, and then the depression came back, and I couldn’t fight it. They’ve adjusted my meds, and we’ll see if it helps. I don’t know where this self-destructive urge comes from, either. Or the self-hatred. It seems so stupid, and so designed to make me feel more pain? Why in hell would I do that to myself? I won’t let myself get to a point where I feel confidence in my music or writing or personhood. Whenever I think about it, that little mental track starts running: “I can’t do shit, I can’t do shit, etc.” Why? Why is my brain interpreting those chemicals and putting them into those ideas? Why?

Well, I guess if it’s chemicals, that’s as good an explanation as any. But it still leaves so much unanswered. I’ve seen the meds dramatically change my thinking. Then I think, if they can affect me that strongly, are they actually determining what I think? Can thoughts be controlled by chemicals? I know they can by hormones. I guess I find it frightening to think that I take this pill and I think one thing, and I take that pill and I think the opposite. And it will come to that one day, if “it’s the chemicals in your brain.”

So even chemical peace doesn’t bring peace. It bothers me. But then, why not? Why not enhance my brain through chemistry?

I guess it’s the same question as whether athletes should enhance their bodies through chemistry. They tend to say no. Why is it different for mental health? I suppose there’s a difference between removing a bad thing, and improving a good thing.

I have known since birth that I’m supposed to be special. I never expected to achieve specialness this way. But being diagnosed bipolar means that I am an outlier, and am quite different from the vast majority of the population. Yeehaw! that was an ironic yeehaw ;-)

jvgr's avatar

Any of the lists are a good start, but self diagnosis is not fool-proof as many of the symptoms are common (singly and in clusters) to other problems as well. You stated that there is a correlation of about 15 symptoms, and you can also see that some of the symptoms are more serious than others.

It’s better to do the right thing badly than the wrong thing well.

If it is you that is of concern, the right thing to do is get professional advice ASAP. This should be relatively easy for you, because you are already concerned and investigating the possibilities.

If it’s a friend, relative or partner you are concerned about, please do your best to convince them to seek professional help ASAP.

Convincing another that they need help is often difficult or even impossible. I’ve advised hundreds of people; those with depression and those with depressed close ones.

The obstacles to getting help for others varies from:
Denial (no I’m not, it’ll pass soon)
Denial because they’ve been taught that depression is a demonstration that they are weak people, or
They are simply too depressed to function clearly and don’t believe they are worth helping, or that help will be ineffective.

It is not at all unusual for a sufferer to refuse help (or acknowledge the need for help) until they hit a rock bottom. The bottom varies with the individual. Those with families tend to drag the family along.

If you are not talking about yourself, be prepared for refusal and, perhaps the need to walk away at some point.

Treated properly, depressive symptoms are easily dissipated. Untreated the outlook is bleak.

As daloon points out, it is a chemical issue, and his own struggles are why current theory suggests that those with chronic clinical depression (my hand is also raised here) are genetically predisposed to it.

jvgr's avatar

PS: Consulting a GP is a good first step and even accepting a perscription from a GP is ok, BUT; GP’s deal with so many types of problems, keeping up to date on anything is difficult. The myriad of drugs available for depression is phenomenal, not to mention the thousands of other drugs for everything else they encounter.

If depression is diagnosed, I always recommend trying to see a psychiatrist because they are medical doctors who specialize in drugs that affect mental well being. That puts them in a better position to fit you to the most appropriate meds.

wundayatta's avatar

BTW, my diagnosis is bipolar disorder, which is almost certainly genetically related. I have two relatives, slightly older than me on my mother’s side that have it (one I didn’t know about, but when I decided to call her to ask about the other, she confessed), and two relatives on my father’s side who are my age. What’s amazing is that my sibling haven’t had problems yet, although I think one of them may have, and may be covering it over.

nikipedia's avatar

Okay. Technical diagnosis requires:

(A) A mood component: do you feel sad, down, anxious, irritable, angry, or any other negative feeling?

(B) At least 4 of the following:
1. Anhedonia, or trouble enjoying things you normally enjoy.
2. A change in your appetite or weight, either increased or decreased.
3. A change in your sleep patterns, again either increased or decreased.
4. Lethargy or fatigue.
5. “Psychomotor agitation,” which means being very fidgety or restless, OR “psychomotor retardation,” which is the opposite—some people describe it like they’re trying to move through water or mud or jello, or their arms and legs feel like they have boulders on them.
6. Feelings of guilt or worthlessness.
7. Trouble thinking or concentrating.
8. Thoughts about suicide or death.

(C) These symptoms must last most of the day, nearly every day, for two weeks or longer.

(D) These symptoms must be so severe that they interfere with your functioning at work, around the house, socially, or any other significant role you perform.

————————

Sometimes it’s hard to tell how much of something like this is normal and how much is not, which is why it’s important to go to a trained professional. It’s surprisingly easy to tell the difference when you’ve seen enough of it.

One of the things that’s very tricky about depression is that it can really mess up the way you perceive yourself and the world around you—not like “the sky is polka-dotted!” perception, but you might think that something is your fault when it clearly isn’t, or you might believe that your family would be better off without you, when they definitely wouldn’t.

Because of that, I think it is really important that if you even think you might be having some problems with depression, it’s worth asking a doctor or counselor what s/he thinks, just in case.

Does that clarify at all? I’m not sure if I answered all your questions….

avvooooooo's avatar

I’m in the mental health field and with what I know (which is really hard to summarize since its such a huge topic and my brain is fried right now) this might be the best website for you to consult.

http://psyweb.com/Mdisord/MoodDis/majordepress.jsp

It lists the diagnostic criteria for Major Depressive Disorder, which is the diagnosis that most people receive when they are diagnosed with “depression.” The criteria for diagnosing depression are found in the Diagnosticians and Statisticians Manual, Fourth Edition, or the DSM-IV. I think that this is one of the more comprehensible websites that I have found, it might not be the best one out there, but it has all the pieces.

One thing that I would caution you against is taking this to your primary care physician. He or she might deal with depressed people, but they deal with a ton of other things and cannot be expected to keep up with the mental health field like people in the mental health field can. Psychiatrists, psychologists, and a whole slew of other people who don’t answer to “doctor” (like me) can help you figure this out. The difference is that they will help you figure it out and not just write you a prescription that many times they will not sufficiently monitor. Far too many times primary care physicians will just prescribe a pill without any of the other things that are necessary for helping a depressed person.

I don’t know if this makes a whole lot of sense right now, I will revisit this question when my brain is not running on empty and make sure! :)

TitsMcGhee's avatar

For the most medically accurate answer, check out the latest edition of the DSM IV (Diagnostic and Statistical Manuel of Mental Disorders, IV Edition). It outlines the minimum criteria for depression of different levels (as well as any other mental disorder). It’s very specific, it’s what psychiatrists and psychologists go by.

bigbanana's avatar

I think in some cases,self diagnosis can lead to creating a worse issue. If you are sad or gloomy, the first thing you could do is get some daily exercise. If you try taking a walk for a week, every day see how you feel before you get MD involved. I think we all feel down sometimes, but talking about those feelings, exercising, getting out and meeting people…all might help. How much time do you spend indoors as opposed to outside in nature? Also music is proven to help moods. And If nothing else, try this for a few weeks and if no change, then see a head doc.

broncosgirl's avatar

I have suffered bouts of depression throughout my life. Currently, I am experiencing another one. It is a feeling of being sad and there is no reason for it. You know you should be happy with the people who love you, the things you do, and the things you enjoy most. But you don’t, and you can’t just “make yourself happy.” Many people don’t understand that part, they think well, just snap out of it. It’s not that simple. You cry for no reason, you get frustrated at miniscule things and you know that it shouldn’t upset you. You can’t find anything that will satisfy that “itch” of sadness. I am one of those people that the meds actually make me feel far more like a zombie than I am already feeling lol, so I try to battle it by distraction and activity until it passes. It usually helps, I just wish there were ways for people to be more educated on it. It is real, it is hard, and you shouldn’t be ashamed of it.

Paxan8's avatar

Clinical depression or chronic depression differs because it is a life long illness. There is an chemical imbalance in your brain that requires medication to even it out. Just as people with high blood pressure, cancer or some other disease require medication so do those with clinical depression. It’s not something that comes about because of a cause, like losing a loved one or a divorce. Unlike other diseases though, even with medication you need have the fortitude to get yourself out of bed and live life. Unfortunately, Americans love to be overmedicated and doctors prescribe meds to people who are just unhappy with their life instead of getting to the cause of their unhappiness, someone who is unhappy with their spouse is probably not clinically depressed, they just don’t want to be married to that person. Clinical depression is a lifelong struggle, one that I have unfortunately have had to deal with, but does require medication if you are going to have a chance of a normal life.

blackenedbloodred's avatar

I’ve been diagnosed with Major Depressive Disorder. My doctor put me on the lowest dose of Paxil, but it was still too strong for me. I couldn’t get out of bed, it actually made me feel worse! So, I stopped taking it. A couple of months past and I went back to him and told him that I stopped taking because of the side effects. So, he prescribed me Celexa which works wonders for me! You have to understand that SSRI’s don’t work overnight and you’ll be experiencing the same symptoms for a couple of weeks if not a month and a half. Then you’ll realize that it does work. I started on Celexa on 10mg so I may not feel sideeffects. I’m currently on 50mg and I think I need to use it for the rest of my life. I’ve tried forgetting to take my pills ranging from 2 days to a couple of hours past the last time I took it and my mood was greatly affected! Let’s just say I’m def not a happy camper! My kids get the most disadvantage, because of my mood. I can’t explain to them how unhappy I am! They won’t understand and I don’t want them to know, because its my problem and not theirs! So, for the rest of my life I have to be on anti-depressants, but I like myself better on it and that’s what matters the most! :D

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